Liz Sabo Johnson, a lead in the Cincinnati Sound Chorus and a participant in the World Choir Games, wasn’t sure why her voice was taking so long to warm up.

Sometimes she didn’t feel completely warmed up until the very end of her rehearsals with the barbershop chorus. Johnson finally learned the reason last week when she took advantage of a special offer during the Choir Games and had a free vocal cord examination by UC Health voice specialists.

The exam was provided at the Duke Energy Convention Center by laryngologist Sid Khosla, MD, and speech pathologist Eva van Leer, PhD, specialists with the UC Health Voice and Swallowing Center and assistant professors of otolaryngology–head and neck surgery.

Van Leer examined Johnson’s vocal cords with a technology called video stroboscopy, and Khosla made the surprise diagnosis.

During the test, van Leer held a long, narrow device with a strobe light and camera that allowed her to view Johnson’s vocal cords in slow-motion on a computer screen.

Vocal cords can vibrate hundreds of times per second, ranging from 70 cycles or vibrations per second for a bass (low) voice to 1,000 vibrations per second for a soprano (high) voice. A hummingbird’s wings, by comparison, flap at about 700 times per second, appearing as a blur to the human eye.

"We turn the strobe light on to make it look as though the vocal cords are vibrating slowly,” van Leer explained. "Think of a strobe light at a nightclub, where everyone looks as though they’re moving or dancing slowly.”

Van Leer deftly inserted the end of the strobe device into the back of Johnson’s mouth without causing her to gag.

Although Johnson has a rich, buoyant voice and was able to produce a ringing mezzo-soprano tone, her vocal cords showed signs of inflammation. Khosla said the culprit was acid reflux, a condition that affects millions of Americans and occurs when acid from the stomach backs up into the esophagus. The condition can cause heartburn as well as irritation to the throat, larynx and vocal cords. Treatment can involve lifestyle changes (e.g., avoidance of acidic foods and late-night dinners), medications and, infrequently, surgery.

Johnson’s exam was one of several provided by the UC Health team during the Choir Games. "It was a free exam that gave people a chance to see what their vocal cords look like,” Khosla said. "Most people who saw us had a cold coupled with something else. When you have a cold or virus, your cords are going to be a little swollen to begin with. And then you’re stressing them by rehearsing or performing. It’s like having a swollen ankle and then trying to run on it.”

Video stroboscopy can pick up benign bumps on the vocal cords as well as more serious problems, such as cancer.

Singers, van Leer said, have the same abnormalities as the general population. The difference, she said, is that "sometimes they can sing around those abnormalities better than people who have less training.”

Like highly trained athletes, singers are highly attuned to their voice, or "instrument,” and they will notice even the smallest change, van Leer added. "Singers will come just to see how their vocal cords look, or when they have a very subtle complaint. If you’re very good at what you do you notice the more subtle changes.”

During a break, Khosla stepped outside his temporary medical office to listen to a glorious a cappella group from Latvia. "The choirs are all pretty amazing,” he said. "I’ve been to several events, and around here at the Convention Center there are always people rehearsing. Being part of the World Choir Games has been a wonderful experience.”

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The UC Health Voice and Swallowing Center diagnoses and treats voice and swallowing disorders that affect the larynx and upper esophagus. The multidisciplinary team includes specialists in otolaryngology, speech pathology, neurology, gastroenterology, pulmonary medicine and radiology. The center uses state-of-the-art technology to provide the highest-quality treatment.